New York Senate Bill S08457

New York 2025-2026 Regular Session

• Introduced: 7/16/25
• Refer: 7/16/25
• Refer: 1/7/26

Caption

Amends the definition of "small group" for purposes of health insurance policies and contracts to fifty employees or fewer; repeals provisions requiring the superintendent to conduct an impact study.

Summary

This bill amends New York’s insurance law to change the definition of a “small group” for health insurance rating and underwriting purposes from groups of up to 100 employees or members back down to groups of 50 or fewer. It makes corresponding changes in both the individual/small group health insurance policy provisions and the parallel provisions for health insurance contracts, including rules for community rating, pre-existing condition limitations, and termination protections. The bill also updates related provisions governing association and trust-based coverage so that member employers or groups with 50 or fewer employees or members are treated as small groups for rating purposes. The bill further continues the prohibition on insurers acting as administrators or claims-paying agents for small groups and on insurers providing stop loss, catastrophic, or reinsurance coverage to small groups, while removing the temporary 2016 exceptions that had allowed certain coverage arrangements for groups with 51 to 100 employees. In addition, it repeals a 2016 law that required the superintendent of financial services to commission an independent assessment of the impact of the stop-loss/reinsurance prohibition on the small group market. The act takes effect immediately, with some provisions tied to existing expiration and reversion dates in the Insurance Law.

Impact

The bill would narrow the statutory small-group market in New York, affecting which employers and member groups are subject to community rating and small-group underwriting rules under Insurance Law sections 3231 and 4317. Employers or groups with 51 to 100 employees would no longer be treated as small groups under these provisions, which could change how they are rated and what coverage options apply. It also preserves and reinforces restrictions on stop loss, catastrophic, and reinsurance coverage for small groups, while eliminating the prior transitional exceptions and repealing the mandated impact study from chapter 12 of the laws of 2016.

Sentiment

No committee transcripts or recorded votes were provided, so there is no documented floor or committee sentiment in the materials supplied. Based on the bill text and caption, the measure appears to be a technical but policy-significant rollback of the expanded small-group definition enacted in 2016, suggesting support from sponsors who favor restoring the pre-2016 framework. The absence of recorded opposition or debate in the provided context means broader legislative sentiment cannot be determined from this record alone.

Contention

The main point of contention is the size threshold for the small-group market: the bill reduces the threshold from 100 employees back to 50, which affects mid-sized employers, municipal groups, and nonpublic schools that had been brought into the broader small-group rules. Another likely point of dispute is the continued prohibition on stop loss, catastrophic, and reinsurance coverage for small groups, since the bill removes the temporary exceptions that had allowed certain 51-to-100 employee groups to maintain or obtain such coverage. Stakeholders most directly affected would be insurers, employers in the 51-to-100 range, municipal corporations or districts, and nonpublic schools, though no explicit stakeholder testimony is included in the provided materials.